High Cost of Medical Care in Kerala Tentative Hypothesis P G K Panikar In spite of a wide network of public sector medical care institutions, where medical serviccs are supposed to be easily accessible and freely available, private expenditure on medical care in Kerala remains very high, THE substantial improvement in the health status of Kerala despite the low level of economic development and income per capita, has attracted attention. It may be noted that as of 1989, the crude death rate in Kerala had come down to 6 as against 10 for India and 13 for low-income economies, excluding India and China. infant mortality rate for the state in 1989 is reported to be 21 compared to 93 for India and other low-income countries The average life expectancy at birth in the state worked out to 70 years, as against the national average of 59 years, and 55 years for the group of low-income economies other than India and China. Thus, in terms of survival norms, the health status of the state is comparable to that in the high- income industrialised countries of western Europe and north America. However, as brought out in an earlier study on the health status of Kerala [PGK Panikar and C R Soman, 1989], and reiterated in a recent study [K P Kannan, K R Thankap- pan, et al] Kerala's health profile presents a strange combination of low mortality and high morbidity. Another dimension of health improvement in the state which has not received due attention is the comparatively high cost of health care borne by the KeratitesWhether it be in terms of the share of the health sector in the state's budget or per capita expenditure, public as well as private, on medical care, the cost of medical care in Kerala seems to be incommensurately high.
